This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yamabe, H. Articles by Hokamura, Y. Search for Related Content PubMed PubMed Citation Articles by Yamabe, H. Articles by Hokamura, Y. Related Collections Electrophysiology

(Circulation. 2001;104:1268.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Demonstration of the Exact Anatomic Tachycardia Circuit in the Fast-Slow Form of Atrioventricular Nodal Reentrant Tachycardia

Hiroshige Yamabe, MD; Yukio Shimasaki, MD; Osamu Honda, MD; Yoshihiro Kimura, MD; Youichi Hokamura, MD

From the Division of Cardiology, Kumamoto City Hospital, Kumamoto, Japan.

Correspondence to Hiroshige Yamabe, MD, Division of Cardiology, Kumamoto City Hospital, 1-1-60 Kotoh, Kumamoto, 862-8505 Japan. E-mail yamabe-hi{at}par.odn.ne.jp

Background— The tachycardia circuit in the fast-slow form of atrioventricular nodal reentrant tachycardia (FS-AVNRT) has not been convincingly defined.

Methods and Results— To define the tachycardia circuit, single extrastimuli were delivered during FS-AVNRT to 9 intra-atrial sites in 12 patients: the His bundle (HB) site; the superior portion of the HB site (S-HB); 3 arbitrarily divided sites on the AV junction extending from the HB site to the coronary sinus ostium (CSOS) (sites S, M, and I); the superior, posterior, and posteroinferior portions of the CSOS (S-CSOS, P-CSOS, and PI-CSOS, respectively); and the CSOS. The inferior portion of coronary sinus ostium (I-CSOS), at which the earliest retrograde activation was observed, was excluded. At each site, the longest coupling interval of the single extrastimulus that reset the tachycardia and the subsequent return cycle was measured. The mean tachycardia cycle length was 370±55 ms. The longest coupling intervals at sites S-HB, HB, S, M, I, CSOS, S-CSOS, P-CSOS, and PI-CSOS were 328±53, 360±55, 358±55, 358±54, 360±55, 338±56, 323±54, 331±56, and 321±58 ms, respectively, and the subsequent return cycles were 408±58, 371±55, 370±55, 372±56, 370±55, 396±56, 411±60, 405±58, and 412±59 ms, respectively. The longest coupling intervals at sites HB, S, M, and I were longer than those at S-HB, CSOS, S-CSOS, P-CSOS, and PI-CSOS (P<0.0001). The return cycles at sites HB, S, M, and I did not differ from the tachycardia cycle length, whereas those at CSOS, S-CSOS, P-CSOS, and PI-CSOS were longer than the tachycardia cycle length (P<0.0001).

Conclusions— The perinodal atrium extending from the HB site to the I-CSOS is an integral limb of the reentry circuit in FS-AVNRT.

Key Words: atrioventricular node • mapping • reentry

This article has been cited by other articles:

				P. Loh, S. Y. Ho, T. Kawara, R. N.W. Hauer, M. J. Janse, G. Breithardt, and J. M.T. de Bakker Reentrant Circuits in the Canine Atrioventricular Node During Atrial and Ventricular Echoes: Electrophysiological and Histological Correlation Circulation, July 15, 2003; 108(2): 231 - 238. [Abstract] [Full Text] [PDF]

				M. D. Gonzalez, L. J. Contreras, F. Cardona, C. J. Klugewicz, J. B. Conti, A. B. Curtis, T. E. Morey, and D. M. Dennis Demonstration of a Left Atrial Input to the Atrioventricular Node in Humans Circulation, December 3, 2002; 106(23): 2930 - 2934. [Abstract] [Full Text] [PDF]

				E. Patterson, B. J. Scherlag, H. Yamabe, Y. Shimasaki, O. Honda, Y. Kimura, and Y. Hokamura Demonstration of the Exact Anatomic Tachycardia Circuit in the Fast-Slow Form of Atrioventricular Nodal Reentrant Tachycardia * Response Circulation, April 9, 2002; 105 (14): e80 - e81. [Full Text] [PDF]